@layout("/common/_form.html",{js:["/assets/yajin/yajin_edit.js"]}){

<form class="layui-form" id="yajinForm" lay-filter="yajinForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="id" type="hidden"/>

                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">押金金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="yajin" name="yajin" placeholder="请输入押金金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">退还日期<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="thTime" name="thTime" placeholder="请输入退还日期" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">缴纳日期<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="jnrq" name="jnrq" placeholder="请输入缴纳日期" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户ID<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="uid" name="uid" placeholder="请输入用户ID" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">商户订单号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="outTradeNo" name="outTradeNo" placeholder="请输入商户订单号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">微信支付订单号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="transactionId" name="transactionId" placeholder="请输入微信支付订单号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">商户退款单号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="outRefundNo" name="outRefundNo" placeholder="请输入商户退款单号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">0未缴纳 1已缴纳 2已退还<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="state" name="state" placeholder="请输入0未缴纳 1已缴纳 2已退还" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>

</form>

@}